Osteopathic Journals and Research by Darren Chandler

 

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  1. Happiness & positivity

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    Introduction

    Given the choice most people would say winning the lottery would improve their happiness but a year later these people adapt and return to previous levels of happiness (Delamothe et al 2005).

    Whilst money can buy you happiness, it can’t buy much, and above a modest threshold, more money does not mean more happiness. This is exemplified by the fact that individuals usually get richer during their lifetime but not necessarily happier (Delamothe et al 2005).

    Social capital is the ties that bind families, neighbourhoods, workplaces, communities and religious groups together. These social factors, as well as a state of authenticity (Lenton et al 2013), correlate strongly with subjective wellbeing (Delamothe 2005 & Lawrence et al 2015). In fact, the breadth and depth of an individuals' social connections are the best predictors of their happiness (Delamothe et al 2005).

    O’Take et al (2006) found an individual's social capital is influenced by the value they place on gratefulness, kindness and life's simple pleasures.

    Happy people place a high value on gratefulness and kindness. This is because happy people experience more happiness and therefore have more happy memories making them more grateful. To re-experience these memories and gratitude happy people not only desire to be kind and are more likely to be so, but are also more attuned to the recognition of kindnesses.

    This leads to a reciprocal relationship between gratitude, kindness, subjective happiness, and good social relationships. Therefore, compared with unhappy people, happy people have close and satisfying relationships and feel more gratitude in their lives (O'Take et al 2006).

    Consciously drawing people's attention to kind behaviour in daily life by 'counting kindnesses' makes their motivations, thoughts, and actions more positive. This can increase their wish to be kind to others, more strongly identify themselves as kind people and encourage kind behaviours toward others which will all increase happiness and promote enduring happier memories (O’Take et al 2006).

    But is there a danger of 'chasing happiness' or pathologically pursuing 'whatever makes you happy'? Should the emphasis be on a self defining action or mindset with happiness or sadness being a less relevant by-product? Having too higher expectation of happiness in one's past, present or imagined future, or placing too much importance on the self-narrative associated with happiness or sadness makes people more brittle as they negatively evaluate their progress (Mauss et al 2011) resulting in self-blame (Cataline et al 2014) and less tolerant views (An et al 2017). This would imply it's the relationship with being happy that defines its positive or negative impact on life as opposed to merely experiencing happiness; this relationship with being happy also defines both the positive and negative impacts of experiencing sadness.

    Happy people typically enjoy better health due to how it permeates through the different facets of their life (Laurence et a 2015). Therefore as well as adding years to your life happiness adds life to your years (Delamothe et al 2005). The health benefits attributed to happiness include:

    • Reduced stress and improved immune function (Strean 2009 & Bennett et al 2003)
    • More successful adaptation (Laurence et a 2015).
    • Better problem-solving skills and coping strategies (Laurence et a 2015).
    • More creative, imaginative, and integrative thinking (Laurence et a 2015).
    • Greater resilience (Laurence et a 2015).
    • Greater ability to deal with adversity (Laurence et a 2015).
    • Improved management of chronic pain through the use of humour (Pérez –Aranda et al 2019).

    These attributes are thought to improve health through socioeconomic and social resources as happy people have more friends (i.e. increased social capital) and increased earnings. However the effect of happiness on self-rated health is largely independent of marital status, education, income, and socioeconomic resources (Lawrence et al 2015).

    What is happiness? There are three different forms of happiness:

    • Hedonic happiness. Hedonic happiness is achieved through experiencing pleasure and enjoyment. It is more of a reflex pleasure that doesn’t require much cognitive appraisal (Medvedev & Landhuis 2018).
    • Eudemonic happiness. This is also called psychological well-being or positive functioning. It comprises six dimensions: purpose in life; personal growth; environmental mastery; autonomy; positive self-regard; and social connections. Note the eudemonic model does not include emotions and life satisfaction (Medvedev & Landhuis 2018).
    • Psychological flourishing. Psychological flourishing includes social relationships; purposeful life; engagement in activities; self-esteem; and optimism (Medvedev & Landhuis 2018).

    A purposeful life elicits positive emotions which positively shapes an individual's perception of their life satisfaction; this contributes to improved emotional well-being and happiness. Lenton et al (2013) argued this must be accompanied by a sense of authenticity without conforming to the expectations of others. This makes the individual feel they are fully self-aware in upholding their values.

    These positive emotions can involve mixed happy and sad emotions that are registered at a level centred around the individual flourishing. Therefore a transient sad emotion e.g. stress and fatigue may lead on to personal growth in a field that leads to a happy emotion e.g. satisfaction, fulfillment and self esteem.

    This is how positive emotions broadens an individual's confidence to build on their abilities to adapt to life's challenges (O’Take et al 2006) which defines their appraisal of themselves, their circumstances and function in society. This self appraisal should be positively balanced between one’s relationships with others and comparing oneself with others (Delamothe et al 2005).

    Obviously this process has to be performed in a genuine way. If at a moment in time an individual follows the path of least resistance for convenience but later on would rather reflect on it to draw a more premeditated desirable conclusion there will be a mismatch between an individual's perception of themselves, their circumstances and function in society and what really is.

    The pursuit of happiness

    “Life’s too short to pursue happiness”

    Whereas some view being happy as a nice thing to have every now and then, others see it as absolutely necessary to their existence (Mauss et al 2011). People with an obsession of pursuing happiness to excess tend to be more depressed, miserable, and unhappy (An et al 2017). Mauss et al (2011) also found the more people valued happiness, the lower were their hedonic balance, psychological well-being, life satisfaction and experience of happiness in situations that should give rise to it. 

    Relating to one’s happiness in an obsessive manner may chase happiness away (Cataline et al 2014) as people negatively evaluate their progress from setting too higher expectations that inadvertently result in them setting themselves up for disappointment (Mauss et al 2011). This can result in self-blame (Cataline et al 2014) and a more extreme less tolerant view of experiencing sadness (An et al 2017). Whilst this is true generally with life or when under low stress people react more positively to valuing happiness when feeling sad (Mauss et al 2011).

    People placing a high importance on pursuing happiness (An et al 2017) and who excessively value happiness as a gauge for determining how worthwhile life is (Cataline et al 2014) experience significantly more loneliness, selfishness and poorer well-being compared to those who are more neutral in pursuing happiness (An et al 2017).

    This is especially true depending on the emotional context. In relatively negative situations people can attribute their unhappiness to the circumstances e.g people are unlikely to be disappointed if they fail to be happy after hearing of a personal loss. In contrast, in relatively positive situations, people have every reason to feel happy, and are likely to feel disappointed when they do not. For instance, people who value happiness may feel disappointed if they fail to feel happy at an event or in a situation where they deem themselves to be entitled. Therefore the more people value happiness, and have a higher expectation of it, the less likely they may be to obtain it (Mauss et al 2011).

    This result of this unhappiness, be it reasonable or from failing to reach an unrealistic expectation of how happy one thought they were entitled to be, is that people are inclined to rely on a negative social comparison. This negative comparison is because their self-concepts are less stable, less clear and less certain; they also perceive, interpret and think about events and circumstances in a more negative way than happy people (O'Take et al 2006).

    This is in contrast to positive emotions that predict higher quality relationships, improved physical health, and better work performance. However, much like excessively valuing and pursuing happiness, a pathological pursuit of positivity or trying to upregulate positivity during a pleasant experience make people feel worse (Cataline et al 2014).

    Prioritizing positivity

    "To improve the golden moment of opportunity, and catch the good that is within our reach, is the great art of life. Many wants are suffered, which might once have been supplied; and much time is lost in regretting the time which had been lost before." Samuel Johnson

    An individual’s self-perceived success, is an aspect of life satisfaction. It requires social relationships, a purposeful life, engagement in activities, self-esteem and optimism (Medvedez & Landhuis 2018).

    These positive emotions include a component of positive affect which prompts individuals to flourish and engage with their environments and partake in activities, many of which are adaptive for the individual, society or both (Fredrickson 2001).

    Positive situations involve mixed emotions of happiness and sadness. For instance, an individual may make a positive lifestyle choice to train for a marathon.

    In such a situation meeting milestones in their training to gauge improvement may boost self esteem and self confidence and make them happy and experience pleasant feelings.

    On the other hand, inconvenient training times, lack of motivation on certain days, injuries and other set backs may make them feel sad and experience unpleasant feelings.

    How an individual evaluates their current state, how introspective they are of short term momentary happy (pleasant) and sad (unpleasant) feelings and how they relate to the need to experience or avoid these feelings is a defining feature of their well-being. It determines if the original positive situation the individual planned i.e. running the marathon, leads to a more positive mind-set and well being or negative mind-set and ill health.

    Medvedev & Landhuis (2018) identified this as the difference between feeling happy as a momentary state of pleasure and being happy as an enduring condition that can come about from positive situations.

    Therefore positive emotions are not solely comprised of happy hedonic emotions eliciting reflex pleasant feelings. For instance, the benefits to experiencing emotions that typically elicit transient unpleasant feelings e.g. anger, can, when reflected upon productively, result in better performance in a confrontational task (An et al 2017). 

    In this example whether experiencing anger makes the individual feel momentarily happy or sad is not the defining feature or of primary importance, it is largely irrelevant; what is relevant, and should act as the primary self-narrative is the deliberate attempt to pre-plan and utilise whatever pleasant or unpleasemt emotions for a positive result. Mauss et al (2011) hypothesised that when people pursue non-emotion-regulatory goals, the limited emotional context means that the goals and how people feel about their progress toward their goals are not in conflict with one another and therefore the individual will experience more happiness.

    Therefore, unpleasant feelings and emotions that may elicit some fleeting level of apprehension, anxiety or sadness, can lead to the successful completion of a positively self defining task. The completion of this positively self defining task through mixed momentary emotions leads to increase life satisfaction (Medvedev & Landhuis 2018). Increased life satisfaction contributes to the self appraisal of the individual's skills and abilities; this broadens their range of thought-action repertories to strengthen their enduring personal resources to continually adapt and progress through life (O'Take et al 2006).

    Obviously not everything has to be about ‘prioritizng positivity’ enduring the ups and downs to experience life satisfaction and self-perceived success. In balance reflex momentary hedonic happiness such as pleasure and enjoyment should be savoured in people's life. Conversley not being in touch with some immediate sad emotions in certain scenarios can have unhealthy negative supressive effects.

    However, when taken to the extreme, an unhealthy linear thinking that craves momentary positive emotions and avoidance of momentary negative emotions creates an entrenched mindset that expects stability with extreme perspectives that are less tolerant to contradictions (An et al 2017).

    This acute introspective awareness of momentary emotions has a place in life-threatening situations. Here a linear thinking narrowed thought–action repertoire promotes quick and decisive action that carries an immediate benefit e.g. momentary emotion: extreme fear - action: run away (Fredrickson 2001). Any contradicting thoughts or actions in this scenario could be life threatening and therefore not tolerated. Day to day such an intense awareness of momentary emotions and a narrow-linear interpretation of these emotions is not needed. To be aware of ourselves engaging, adapting and flourishing in our environment we need a less introspective approach to our momentary emotions in order to elicit a broader more tolerant and lateral thinking though-action repertoire.

    This tolerant, lateral thinking more broader thought-action repertoire builds personal resources that broaden habitual ways of thinking or acting. This ranges from physical and intellectual resources to social and psychological resources; they allow the individual to play, explore, savor, integrate and envision future achievement (Fredrickson 2001) without getting bogged down with transient emotions.

    When thinking about, and valuing momentary happy and sad emotions is less extreme, as when prioritizing positivity, there is a greater expectation and acceptance of change for better or worse. This leads to a more malleable thought process allowing for a greater tolerance of contradictions (An et al 2017).

    Therefore prioritizing positivity is defined by how an individual seeks out positivity by making decisions in how to organize their day-to-day lives. It is associated with a host of beneficial well-being indicators such as (Cataline et al 2014):

    • Experiencing more frequent positive emotions and less depressive symptomology.
    • Access to greater resources such as self-compassion and ego-resilience.

    The danger of jumping from positive situation to positive situation is that we loose sight of the fundamental purpose of enjoyment. Realising one set of aspirations, can immediately lead to more ambitious aspirations, to which we transfer our hopes for happiness. As Samuel Johnson observed human traits seem to dictate that “life is a progress from want to want, not from enjoyment to enjoyment”  (Delamothe et al 2005).

    Positive emotions can be promoted through the use of humour. Using humour to cognitively reappraise a situation helps to distance oneself from the negative emotions and promotes resilience. This helps the individual view the negative situation as a challenge rather than a threat and refocus and reappraise the situation using positive emotions (Pérez –Aranda et al 2019) that may, as a side effect, induce temporary feelings of happiness or sadness.

    Happiness through humour

    Appropriate humour creates an environment that promotes learning and is a vital communication tool. Palliative care experts believe that the value of humour should not be trivialized, even in the end-of-life setting (Samant et al 2020). The value of humour is:

    • Attracts and sustains attention (Savage et al 2017) and improves energy levels (Fu et al 2020).
    • Produces a more relaxed and productive learning environment (Savage et al 2017) by dispersing tension (Fu et al 2020).
    • Reduces stress and anxiety by improving coping mechanisms (Samant et al 2020), shifting perspectives (Fu et al 2020) allowing for cognitive reappraisal (Pérez –Aranda et al 2019) and dealing with misfortune (Wilkins et al 2009).
    • Enhances participation and increases motivation (Savage et al 2017)
    • Facilitates interpersonal communication and attraction (Pérez –Aranda et al 2019) whilst improving trusting relationships (Samant et al 2020).
    • Builds bonds with others (Wilkins et al 2009). Laughing can signal to others our intentions of using humor to play out and practice certain kinds of social interactions (Libera 2020). The strength of a student-teacher relationships has a greater impact on student success than socioeconomic status (Savage et al 2017).
    • Improves quality of life for patients (Samant et al 2020) by strengthening an individual’s physical, psychological, and spiritual abilities (Fu et al 2020).
    • Makes sense of rule violations (Wilkins et al 2009).

    Awareness of negative types of humour that are best avoided, include mocking, sarcasm, and criticism (Samant et al 2020).

    Some patients report humour to be the quality that they most valued in their cancer care to decrease anxiety to help cope and deal with their disease with 86% declarimg it "some what important” or “very important” (Samant et al 2020).

    One cancer patient described:

    “The other reactions; anger, depression, suppression, denial, took a little piece of me with them. Each made me feel just a little less human. Yet laughter made me more open to ideas, more inviting to others, and even a little stronger inside. It proved to me that, even as my body was devastated and my spirit challenged, I was still a vital human” (Strean 2009).

    Humour also has positive physiological effects, such as decreasing stress hormones like epinephrine and cortisol and increasing the activation of the mesolimbic dopaminergic reward system (Brandon et al 2017). This decrease in stress hormones may explain the connection between laughter and enhanced immune function (Strean 2009 & Lawrence et al 2015) including improving NK cell activity (Bennett et al 2003). This is proposed to increases morbidity in the population as a whole (Lawrence et al 2015) and in patients with cancer and HIV (Bennett et al 2003).

    Pérez –Aranda et al (2019) also associated humor with reductions in growth hormones.

    Happiness as a meeting of minds (Tenney et al 2009)

    Individuals with similar personality patterns like each other more than individuals with dissimilar patterns. However, this was more prevalent for similarities of undesirable traits rather than desirable traits.

    This can be in contrast to the fundamental principle of liking that states people like others to whom they attribute generically desirable personality traits (e.g. generosity, kindness) and dislike others to whom they attribute undesirable traits (e.g. arrogance, rudeness).

    This attraction of people who exhibit the same personality traits was thought to be because people automatically like whatever reminds them of themselves. This familiarity is easier to perceive and interpret and is experienced as pleasurable.

    The stronger association individuals have with others that share their negative, as opposed to positive personality traits are thought to be from:

    • Positive traits are often encountered and rarely hidden. They are clearly advertised so are easy for everyone to perceive and understand. Therefore, there is no personal intimate benefit to being familiar with someone’s positive traits because everyone would be familiar with them.
    • Negative traits are viewed in multiple degrees of negativity; positive traits are viewed as generically positive with less fluctuation therefore it is more difficult to ally yourself with a comparable score. This makes it more easy to accurately associate yourself with someone else’s negative personality traits as there’s a more accurate measure.
    • People with similar patterns of positive traits understand each other better and see their own positive traits in others in an especially positive light. This can breed a competitiveness as the individual is no longer unique and indispensable negating any added benefit to their encounter.

    Humour and chronic pain (Pérez –Aranda et al 2019)

    Humour is a behavioural endurance strategy described as one of the possible ways to react to pain. It can modify emotion related temperament i.e. cheerfulness, seriousness and bad mood and influence motivational states.

    In chronic pain, i.e. persisting for more than three months, this can be associated with mental and emotional problems or disabilities in daily functioning, as well as difficulties participating in social activities.

    In the fear avoidance model of chronic pain the meaning associated with the pain experience is a key aspect in the development of fear of pain and, therefore, avoidance behaviours. The process by which chronic pain leads to disability seems to be mediated by variables such as sensitivity to anxiety, depression, distress, fear of pain, catastrophism, and body vigilance.

    Humorous stimuli or tasks may impact on health due to distraction and cognitive reappraisal. However, the humorous stimuli needs to match the individual’s preferences and that being able to choose the humour is an important part of the phenomenon. Therefore ‘imposing’ an ego or comedy style upon a patient may not work. Using humour to manage chronic pain can work through two forms:

    • Distraction has been shown to be an effective strategy for dealing with pain. This is because the perception of pain is suppressed by consciously focusing attention on the nonpainful, humorous, stimulus.
    • Cognitive reappraisal of stressful events promotes resilience and well being. Using humour enables individuals to view stressful situations as challenges rather than threats to gain a sense of mastery over the situation. It also helps distance oneself from the emotional impact of an event and refocus on its positive aspect. This would help individuals reappraise pain in retrospect as less negative and stressful.

    Developing social support through the use of appropriate humour may initiate and sustain friendships more easily enabling the patient to achieve more satisfying social relationships which can help cope with chronic pain.

    Happiness through situations and comedy

    “Until the scientists work out all the details, get in all the laughter that you can!” Robert Provine, Laugh Out Loud

    Pérez –Aranda et al (2019) identified four general types of humour style:

    • Affiliative humour uses humour to affirm oneself and others.
    • Aggressive humour is impulsive and derisive toward others such as sarcasm, teasing, and ridicule.
    • Self-enhancing humour maintains an optimistic outlook on life when stressful events arise, so it could also be considered as the coping type of humour.
    • Self-defeating humour which consists of allowing oneself to be the butt of jokes to gain others’ approval.

    Affiliative and self-enhancing humour are associated with positive outcomes such as cheerfulness, self-esteem, intimacy, relationship satisfaction and predominant positive moods. This may have analgesic effect.

    Aggressive and self-defeating humour have been associated with neuroticism, stress, anger, depression and anxiety, low self-esteem and negative moods.

    However even though self-defeating humour was associated with more pain with low level of daily stresses, both self-defeating humour and aggressive humour were found to play an adaptive role when daily stresses were high. Both self-enhancing and self defeating humour has been associated more with happiness than the other humour styles.

    How these different humour styles are vocalised and played out involves four theories of their delivery:

    • Incongruity theory.
    • Superiority theory.
    • Arousal theory.
    • Combination theory.

    Incongruity theory

    Incongruity theory states humour results when our brains perceive two things as coexisting in a manner that does not at first appear to make logical sense. Laughter or humour occurs when the discomfort caused by this incongruity is resolved in some way. A simple example of this is a pun (Libera 2020). 

    For this to occur people must be aware of appropriate or inappropriate behaviour in social situations (Savage et al 2017).

    Libera (2020) found variations in incongruity theory to include:

    • When social roles are reversed: the powerful are taken down or the powerless become powerful, as occurred during medieval carnivals when a peasant became a carnival king for the day.
    • When there is a simultaneously violation of norms seen as being benign

    Superiority theory

    Superiority theory dates back to the writings of Plato and Aristotle and suggests that the primary motivator for humour is triumph or pleasure at the pain, flaws, or indignities of others. It requires ridicule, disparaging or belittling others. This involves laugh “at” something or someone because that person is seen as being genuinely less than ourselves (Libera 2020).

    Arousal theory

    Defines humour as a complex interaction between emotion and cognition.

    Individuals will describe the humour as appropriate and possibly funny or inappropriate based on whether the targeted subject is associated with them personally or not.

    Combination theory

    Libera (2020) combined these three models as well as the tension-release theory. She broke this combined theory into three elements:

    • Recognition: describe something familiar. This shared observation supports or reflects the audience’s experiences of the world creating a bond through mutual understanding.
    • Pain: what would the world’s worst version of a particular occupations do or say? For example describing the worst first date.

    This generates tension, cognitive dissonance (contradictory thoughts, beliefs and values), and embarrassment or shame. For example: The Office.

    Releasing tension and recognizing awkwardness or discomfort without making any kind of formal joke can lead to laughter. Laughter is inherently social and shared laughter creates more points of connection.

    • Distance: this allows us to reflect on these experiences with some degree of objectivity, equanimity, or sense of safety, perhaps making them benign. Very painful or highly taboo subjects require a great deal of distance in order to feel funny.

    References

    Wilkins J, Eisenbraun A (2009). Humor theories and the physiological benefits of laughter

    Fu X, Wu L, and Shan L (2020). Review of possible psychological impacts of COVID-19 on frontline medical staff and reduction strategies  

    Pérez-Aranda A, Hofmann J, Feliu-Soler A, Ramírez-Maestre C, Andrés-Rodríguez L , Ruch W, Luciano J  (2019). Laughing away the pain: A narrative review of humour, sense of humour and pain

    Bennett M, Zeller J, Rosenberg L, McCann J (2003). The effect of mirthful laughter on stress and natural killer cell activity

    An S, Ji L, Marks M and Zhang Z (2017).Two Sides of Emotion: Exploring Positivity and Negativity in Six Basic Emotions across Cultures

    Savage B, Lujan H, Thipparthi R, and DiCaHumor S (2017). Laughter, learning, and health! A brief review  

    Anne Libera A (2020). The Science of Comedy (Sort of)

    Samant R, Balchin K, Cisa-Paré E, Renaud J, Bunch L, McNeil A, Murray S, and Meng J (2020). The importance of humour in oncology: a survey of patients undergoing radiotherapy

    Tenney E, Turkheimer E, and Oltmanns T (2009). Being Liked is More than Having a Good Personality: The Role of Matching

    Catalino L, Algoe S, and Fredrickson B (2014). Prioritizing Positivity: An Effective Approach to Pursuing Happiness 

    Strean W (2009). Laughter prescription

    OTAKE KSHIMAI STANAKA-MATSUMI JOTSUI KFREDRICKSON B (2006). HAPPY PEOPLE BECOME HAPPIER THROUGH KINDNESS: A COUNTING KINDNESSES INTERVENTION

    B. Mauss I, Tamir M, Anderson C, Savino N (2011). Can Seeking Happiness Make People Happy? Paradoxical Effects of Valuing Happiness

    Delamothe T (2005). Happiness. Get happy—it's good for you

    Medvedev O and Landhuis E (2018). Exploring constructs of well-being, happiness and quality of life

    Lawrence E, Rogers RWadsworth T (2015). Happiness and longevity in the United States

    Fredrickson B (2001). The Role of Positive Emotions in Positive Psychology. The Broaden-and-Build Theory of Positive Emotions

    Lenton ABruder MSlabu LSedikides C (2013). How does "being real" feel? The experience of state authenticity

  2. Ideomotion & fascial unwinding

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    Involuntary motion soft tissue techniques: Fascial Unwinding, Pandiculations and Muscle Repositioning

    Fascial Unwinding

    Minasny (2009) found fascial unwinding to involve two apects:

    • Passively moving the patient in response to sensations of movement.
    • Inducing involuntary movement by using an initiation or induction technique.

    Induction techniques initiates fascial unwinding that results in the patient responding with spontaneous expressions of movement in either a rhythmic or chaotic pattern.

    The induction process is initiated by lifting and holding certain body parts to remove the influence of gravity as to overcome reactive proprioceptive postural tone. When the effects of gravity are removed, any strain patterns held in the tissues are more easily felt. The therapist follows any hint of movement without directing or forcing it. This involves the practitioner being largely passive but constantly aware of feedback from the patient's tissues (Minasny 2009).

    Pandiculations

    Schleip (2017) described another proprioceptive stimulating approach to produce involuntary movements called pandiculations. This was from the patient performing slow continuous resisted movement in a concentric and eccentric fashion whilst their soft tissues are being worked upon. This is usually repeated for sixty to ninety seconds followed by a brief isometric contraction of the antagonistic muscles.

    Muscle Repositioning

    Bertolucci (2010) described a technique called Muscle Repositioning that also worked on pandiculations. This author found involuntary movements to be produced as a result of internal shear forces among myofascial compartments. These shear forces are produced from the practitioner applying precise and sustained firm pressure at an oblique angle which produces a counter pressure generated from the inertia of the tissues.

    The resultant involuntary movement happens in small increments (pandiculation), which become larger towards the end of the manoeuvre as body segments unite into a block. After the manoeuvre the patient often feels a burning sensation.

    Somatic Experiencing 

    Payne et al (2015) described the theory of Somatic Experiencing. The sympathetic nervous system may get “stuck” in a state of excess activation; this results in altered muscular activity disturbing the proprioceptive feedback that results in a failed reciprocal activation of the parasympathetic nervous system. This sympathetic-parasympathetic nervous system imbalance impacts on the neuroendocrine axis.

    In Somatic Experiencing rebalancing the nervous system can be achieved by intense muscular effort and manual techniques producing involuntary spontaneous movements of the body such as gentle shaking and subtle postural changes. This is often accompanied by feelings of fear, sadness, or relief. It accounts for shaking and crying after an intense bout of sympathetic arousal and also, possibly, tonic immobility.

    Therefore proprioceptive feedback is integral to allow the autonomic nervous system to reset to baseline. By drawing the patient's attention to the proprioceptive and kinesthetic (somatic) markers of this “release” process it enables a spontaneous rebalancing of the nervous system.

    Proprioception 

    Proprioception and involuntary motion

    Ideomotion is the proposed mechanism for involuntary motion in fascial unwinding (Minasny 2009) and cranial osteopathy (Mason 2008); refer below 'Ideomotor theory' and 'Ideomotion and fascial unwninding'

    Ideomotor actions are unconscious involuntary movements caused by prior expectations, suggestions, or preconceptions (Minasry 2008). Hence:

    Ideation: thinking about or activating the mental representation of a perceived outcome and experiences --> motion: behaviour expressed through involuntary motor action. 

    An example of an ideomotor activity is closing your eyes to go to sleep. An individual's representation (i.e. their ideation) of closing their eyes to go to sleep maybe the anticipation and mental representation of darkness, the closure of heavy eyes and uncosciousness. This leads to the non-deliberate, intuitive motor response (i.e. motion) of the individual closing their eyes (Wirth et al 2018).

    Whilst all ideomotor responses look intuitive, some have to be learnt. For instance an ideomotor response would be an emotion e.g. positivity (ideation) triggering a motor response in the form of adopting a particular posture e.g. upright posture (motion). This would have been learnt when young through observation and role play. This ideomotor repsonse is bi-directional so when older and the association with posture and emotions are 'cemented in' to form a ideomotor reflex, activey changing a posture, in a particular situation can intern be therapeutic leading to a change of emotions.

    The body's ability to preform these involuntary ideomotor actions are based, amongst other things, on proprioceptive feedback (Ondobaka & Bekkering 2012). Proprioception is not just centred around the awareness of the positioning of your body in space but the learning and emotions that accompany this (Liutsko et al 2016, Fuchs & Koch 2014 & Abraham et al 2020); refer below 'Proprioception and learning' and 'Proprioception and emotions'.

    Therefore proprioceptive information, through learming and emotions, has a mental representation of the specific actions that had caused them. These learnt emotional mental representations form sensory anticipations that can trigger automatic ideomotor actions (Wirth et al 2016).

    For example when performing a lumbar roll if a patient has a negative emotional representation of the technique causing tension and anticipation this can heighten proprioceptive feedback. This anxiety and proprioceptive feedback can trigger both voluntary tightness in the paraspinal muscles and a involuntary learnt ideomotor reflex repsonse to such anxiety and vulnerability in the form of neck extension, facial muscle tension and hand and feet clenching. With the ideomotor reflex being bi-directional addressing these learnt ideomotor motor responses i.e. the neck extension, facial muscle tension and hand and feet clenching should reflexly both reduce anxiety and relax the paraspinal muscles for a more efficient technique. 

    Much like with the emotional representation of sleep triggering the automatic motor response of closing the eyelids the learnt emotional and motor repsonses to proprioception are manifested through involuntary ideomotor movements (Ondobaka & Bekkering 2012). It is also why manual stimulation of proprioceptors has been associated with exciting the ideomotor reflex manifested with the involuntary motor movements in myofascial release (Minasny 2009) and cranial osteopathic techniques (Mason 2008).

    What is proprioception

    Proprioception means perception of ourselves, or more exactly, perception of the relative positions of the parts of our body (Liutsko et al 2016). 

    Fascia is the richest sensory organ in the human body as a vast majority of sensory nerve endings in musculoskeletal tissues originate in it (e.g. perimysium and endomysium). Muscular-tendinous expansions insert into the fascia that transmit mechanical tensions to it. This in turn activates free nerve endings and other fascial receptors that contribute to accurate sensing of joint range of motion and positioning. Fascial stiffness has been linked with decreased proprioception and chronic sympathetic activation (Abraham et al 2020).

    All this afferent information acts as “an anchor for self-awareness” (Liutsko et al 2016) as we perceive our self-awareness, feelings, mood, stress, energy and disposition from our physical bodies as a representative of all aspects of our physiological condition (Abraham 2020).

    Abraham (2020) identified sensory-proprioceptive information (or feedback) from fascia to include body contour and physical proportions; this information forms a mental representation of the body and its parts in space and in relation to each other (i.e. body schema). Disorders in body schema are reflected in connective tissue patterns.

    Emotions and body states are closely interrelated, and modifications of one lead to changes in the other. Proprioception “encodes” these moods, feelings and attitudes so that have a bidirectional facilitation interference with movement. "happy movement <--> happy emotions".

    This is why not only body sensations, but also body postures, gestures and expressions are inherent components of emotional experience that influence our evaluation of people, objects and situations, as well as memory recall (Fuchs & Koch 2014). 

    This is exemplified by how the following movements and postures effect behaviour and emotions:

    • Approach movements have a bidirectional facilitation interference with positive moods, feelings and attitudes such as being excited, alert and determined (Liutsko et al 2016). 

    During an approach movement (e.g. arm flexion or receptive movement of the hands) an individual has a more positive evaluation of imagery and target objects (Fuchs & Koch 2014). 

    • Avoidance movements have a bidirectional facilitation interference with negative moods, feelings and attitudes such as being upset, guilty, and jittery (Liutsko et al 2016).

    During an avoidance movement (e.g. arm extension or unreceptive movement of the hands) an individual has a more negative evaluation of imagery and target objects (Fuchs & Koch 2014).

    • When people stand or sit for 7 min in a “power position” (different forms of extension of the body), they perform better in subsequent job interviews (Fuchs & Koch 2014).
    • Shorter movements are associated with Inhibited people, while broader movements are associated with excited people (Liutsko et al 2016).

    This association of emotion with proprioception and movement can also be compounded by other sensory inputs such as emotive language e.g. “love” and “hate” that are related with approach and avoidance gestures respectively (Liutsko et al 2016). Similiar metaphors can also be used in visualisation or motor imagery (Abraham et al 2020).

    So when individuals are able to adopt or produce emotion-specific postures, facial expressions or gestures they tend to experience the associated emotions, which effects their behaviour, preferences, judgement and attitudes toward objects or people.

    Conversely, when an individual’s expressive movements are inhibited, this impairs their experience and processing of the associated emotions (Fuchs & Koch 2014). Mason (2008) found clinically this may manifest itself as isometric muscle contraction “holding yourself tight" or "holding tensions in”. 

    There is also a bidirectional correlation with emotion and muscular tension and postural changes. Studies cited by Fuchs & Koch (2014) highlighted:

    • When slumped, individuals recall more negative life events; conversely more positive events are recalled when sitting upright.
    • Activation of the smiling muscles (by asking participants to hold a pen between their teeth) causes individuals to judge cartoons funnier than when smiling is inhibited by holding the pen between their lips.

    The link between motion and movement is not only experienced by the individual but also by the observer. This can develop ‘kinaesthetic empathy where an observer perceives someone to move in a way that resonates with their own kinaesthetic representation of these movements. 

    Therefore someones expressive behaviour affects the intensity of emotions experienced by not only the individual, but also the observer. This can be seen when experiencing emotions from someone's facial expressions or looking at professional dancers, musicians and sportsmen. This can also ead to congrugent motor responses in the observer e.g. reciprocating to anothers facial expressions.

    Developing kinaesthetic empathy from observation further reinforces our own personal value on proprioception for learning and developing emotional expression and emotional intelligence.

    Proprioception and learning

    When starting to learn a new skill, we rely more on abstract learning. This involves using concentrated attention and deliberate motor movements to observe and master the action we have been tasked with learning. We can only gain feedback on this deliberate movement, as to develop a perception or mental representation of it once we've completed and analysed the movement. An example of this would be when we first learn to write and we assess the size and smoothness of the lines once we've deliberately and consciously moved the pen.

    With repeated practice we then learn on a proprioceptive level. This is where we start to look like we're operating on autopilot acquiring automatic or “embodied” knowledge (Liutsko et al 2016). Weimer et al (2001) attributed proprioceptive deficits as attributing to the "clumsiness" witnessed in Aspergers and is associated with these patients nonverbal learning.

    Our perceptions or mental representations from proprioceptive feedback determine how we perform a task. An example of this would be observing how our writing unconsciously changes over the years once we can write fluently without conscious thought or how our emotions when for example writing an angry letter effect our proprioceptive feedback to determine non-conscious motor reponses in the muscles determining subtle changes in handwriting and pen pressure.

    Embodied knowledge is the knowledge we obtain from all of our sensory, motor, and affective patterns. We process all this information to provide structure to our understanding so that we can engage with our world. This is different from an abstract intellectual grasping of concepts and their relations (Johnson 2015).

    Proprioception is ideal for learning and processing this automatic or embodied knowledge (Liutsko et al 2016). This is because proprioception is key to bodily resonance, be it in the form of sensations, postures, expressive movements or movement tendencies (Fuchs & Koch 2014).

    By using mimetic reproduction, from observing day-to-day movement, actions and expressions, proprioception is integral to learning cultural habits and the know-how associated with practical experience and professional skills (Liutsko et al 2016).

    This process of learning forms and shapes development in a child when playing with toys. A child fuses movement and proprioception with emotion when they play with a favourite toy to create emboded imagery.

    A child will identify with the toys qualities, movement and expression. They then emotionally and physically engage with the toy by moving it in an expressive manner transfering all this neural input to internally represent aspects of their own ego identity (Liutsko et al 2016).

    It's not until five years old that a child can transfer behavior control from external to internal speech and inhibit their own responses (although they can inhibit their responses before this in response to external command). Therefore up until five a child has a blank cheque to fuse unhibited expression of movement with learning (Greenwald 1970).

    This form of learning using all of our sensory, motor, and affective patterns is not only exclusively dependent upon proprioception. Many subconscious thoughts, emotions and perceptions play an influence in the process of observing and learning in this fashion. For example Fuchs & Koch (2014) identified studies showing how bodily felt warmth i.e. thermal heat from holding a hot drink, directly translates to impressions of emotional warmth. This can effect observations and perceptions during intuitive learning.

    Proprioception and emotions

    “The term “emotion” is derived from the Latin emovere, “to move out,” implying that inherent in emotions is a potential for movement, a directedness toward a certain goal (be it attractive or repulsive) and a tension between possible and actual movement” (Fuchs & Koch 2014). 

    This is mirrored with the use of such language towards emotion where people describe being “moved” or “touched” or a “sinking feeling” or being “uplifted”.

    Proprioception plays an important role in the construction of movements, formation of movement skills and in regulation of muscle tone. Proprioception also contributes to speech function or speech kinaesthesia and to general physical well-being and “sense of cheerfulness” (Liutsko et al 2016).

    As the richest sensory organ in the body, fascial stiffness, from its contractile properties, fluid dynamics and myofascial relations has been associated with emotional stimuli. This could be as fascia’s efferent nerve endings account for more than 50% of its total nerve supply and are associated with a sympathetic response i.e. vasodilation. Sympathetic nerves are also located outside the vicinity of blood vessels questioning what their function maybe (Abraham et al 2020).

    The correlation between proprioception and emotion can be reflected by its neurological links with:

    • Facial feedback: skeletal muscle afferent signals from facial expressions regulate emotional experience and behaviour.
    • Visceral feedback: visceral feedback from, for example, respiratory, heart function and the gut, are also correlated to emotional experience and behaviour.

    This proprioceptive and interoceptive feedback from the body is integrated with more cognitive information in order to guide one's behaviour particularly with regards to every day decision-making (Fuchs & Koch 2014). 'Emodied cogntion' defines the bi-directional nature and how fundamentally potent the perception and representation of actions are to bodily and emotional experiences.

    The relationship with emotions and bodily functions (including proprioception) where one can influence and manifest the other is illustrated in the quote: 

    “We do not shiver because we are scared of the lion, but we shiver as this is what we feel as our fear” (James 1884, as cited in Fuchs & Koch 2014).

    To extend this concept further other people can tickle you but you can't tickle yourself. Therefore how we process the perception of our emotions determines why what we feel as a tickle when someone else tickles us is different to what we feel as a tickle when we tickle ourselves. Consequently the tickle itself doesn't produce reflex bodily functions e.g. laugher and drawing away movements, but how we feel about, or process the tickle does.

    How we feel about and neurologically process the information to determine how tickly something is is determined by how close the match is between the expected response and actual response. By tickling ourselves we remove the anticipation of the unknown causing the cerebellum to diminish activitation in the somatosensory cortex (Simpson 2001). This reflexly determines the motor reaction to this processed afferent stimuli. Could this open the scope for mindfulness practice in addressing fear avoidance behaviour to alter the perception of proprioceptive and emotional feedback which will in turn modify their motor responses?

    Therefore, feeling something and feeling oneself are inextricably bound together. This comes back to our the fundamental definition of proprioception by Liutsko et al (2016) of “the perception of ourselves”.

    This emotion-somatic connection is bidirectional because just as an emotion (e.g. fear) will produce a somatic response (e.g. trembling) bodily (somatic) feelings produce an emotional response. For instance, being afraid is not possible without feeling oneself tremble, tense up, have palpitations, etc.

    Other bodily systems are of course involved in this whole body systemic process e.g. smell, taste, auditory stimuli etc.

    Any disturbances in life, stress, trauma and illnesses effects the proprioceptive state that both reflects in and is related to physical, emotional and cognitive functions (Liutsko et al 2016).

    Liutsko et al (2016) identified examples of personality symptoms with disturbed proprioceptive function:

    • Autism: 80% of subjects with Asperger Syndrome displayed motor dyspraxia. Weimer et al (2001) identified proprioceptive deficits, rather than motor deficits,  as explaining the incoordination observed in Asperger Syndrome 
    • Clinically avoidant personality traits showed significantly poorer motor performance.
    • Down’s syndrome scores were significantly lower for both gross and fine motor skills, as well in running speed, balance, strength and visual motor control.
    • Bipolar disorder: demonstrates altered postural control.
    • Dysfunctions of both proprioceptive and sensory integration of proprioception and vision in personality disorders, aggressive behaviour and prison inmates.

    Our bodies response to an emotional stimuli is its voice describing its “embodied appraisal” of a situation (Fuchs & Koch 2014); therefore proprioception has a critical role in listening to this appraisal and reorganizing the subsequent recovery of these neuromotor systems (Liutsko et al 2016).

    Involuntary motor reactions in response to involuntary motion soft tissue techniques

    Examples of involuntary motor reactions are:

    • Isometric contraction of the cervical erector spinae during a suboccipital inhibition technique. This results in the practitioner’s hands being pressed into the table by the involuntary extension of the subject’s head and upper cervical spine. The cervical region may show a greater responsiveness than other body parts due to its richer proprioceptive innervation (Bertolucci & Kozasa 2010).
    • Eyelid flickering (Minasy 2009).
    • Horizontal eye movements (Minasy 2009).
    • Tremors (Minasy 2009).
    • Clonic and tonic appendicular movements (Minasy 2009).
    • Rising from a supine to a seated position (Minasy 2009).

    Ideomotor theory

    "The act comes first, the word proceeding from it as its concretized efflorescence" . Corporeal Words: Mikhail Bakhtin's Theology of Discourse Alexandar Mihailovic (1997). 

    In sensorimotor learning one interprets the sensory world and responds to it with the motor system (Makin et al 2016). With sensorimotor learning it's not until we've performed the motor action that we see, understand and gain feedback on what the effects of them actions are. Therefore the movement is not guided by the perception of an action, because the perception can only be gained once the action has been performed and analysed, and the movement does not seem involuntary as it is being performed in a very deliberate conscious manner.

    In an ideomotor activity when people perform a movement and observe its subsequent effect, they acquire a bidirectional action-effect association (Vogel et al 2020). This means, as opposed to movement derived from sensorimotor learning, that eventually, merely thinking of an outcome triggers an automatic, seemingly involuntary, associated action (Sun et al 2020). In other words the ideomotor action is born from a central idea releasing, triggering and giving life to the teed up muscular system.

    This is why visualisation (motor imagery) has been shown to positively affect motor and cognitive performance and other behavioral outcomes e.g. anxiety, motivation, and confidence. It does this by eliciting brain activation similar to that during physical execution (movement, proprioception, pain, and body schema) to improve interoception and potentially even the physical structure of fascia as a sensory and motor organ (Abraham et al 2020).  

    This bi-directional response-outcome (R-O) association (Sun et al 2020) can be summarised as:

    • Initially to achieve a desired response one learns:

    Behaviour expressed through voluntary motor movements --> response --> perceived outcome. 

    • A learning phase ensues where a motor act triggering a bodily or environmental effect (Massen & Prinz 2008) becomes hard wired in the brain. This then results in the sequence of events being able to be performed in reverse:

    Ideation: thinking about or activating the mental representation of a perceived outcome and experiences --> motion: behaviour expressed through involuntary motor action. 

    Therefore in ideomotion focusing on and anticipating an outcome, e.g an emotion or environmental goal, will, enhance motor learning. In order for this process to occur two criteria must be met:

    • Clear goal. There has to be a clear idea or representation of what is being willed or intended. This goal has to resonate with the individual (Massen & Prinz 2008) as a compatible rewarding stimulus.
    • Blind positive association. All antagonistic impulses and thought should be removed (Mason 2008 & Massen & Prinz 2008).

    If these two preconditions are fulfilled the internal representations of what is intended has the power to evoke corresponding actions. This is because actions are represented through what their perceived to do and represent (Massen & Prinz 2008). Therefore ideomotor actions are intended to satisfy these perceptions and mental representations rather than be grounded in conscious abstract thinking.

    Maquestiaux et al (2020) found ideomotion can be facilitated and encouraged when a task is ideomotor compatible. This is characterised by the individual recognising a high level of similarity between the stimulus and the associated response (e.g. seeing an arrow point to the left and then pressing a left key).

    Conversely involuntary ideomotor activities can be voluntarily overruled and inhibited. This may occur when an expression of movement is culturally or socially unacceptable in which case it may become inhibited or suppressed. Clinically this may manifest itself as isometric muscle contraction (Mason 2008) “holding yourself tight" or "holding tensions in”. One can speculate if this can be transferred from practitioner to patient during a treatment i.e. if the practitioner is in a state of tension could this cause the patient to inhibit the free expression of their ideomotion?

    This mechanism of ideomotor action has been used to explain various instances in which the environment triggers behaviours in an automatic fashion.  For instance:

    • Mimicry (Sun et al 2020).
    • Behaviour from affordances e.g. pressing a button that looks like it should be pressed (Sun et al 2020).
    • Goal-directed behaviour and action priming (Sun et al 2020).
    • Body language, facial expression or body posture (Mason 2008).
    • Yawning (Mason 2008).
    • Postural correction (Mason 2008).
    • Closing your eyes to go to sleep (Wirth et al 2018).

    Ideomotion and fascial unwinding

    Ideomotor actions are unconscious involuntary movements that are performed by a person. It may be caused by prior expectations, suggestions, or preconceptions (Minasry 2008).

    Ideomotor action has two important characteristics (Minasry 2008):

    • The patient is not aware of causing the movements, and therefore the movements are ascribed to an external force or power.
    • The movement feels unnatural, and thus the external forces perceived are usually regarded as being mystical or paranormal in nature.

    Minasy (2009) ascribed ideomotion as the motion experienced by patient and practitioner during fascial unwinding. Mason (2008) also attributed it to the palpatory phenomenon described when performing osteopathy in the cranial field. It is proposed to work through three mechanisms (Minasy 2008):

    • Stimulation of fascial mechanorecpetors to produce reflex motor effects.
    • Suggestion or guiding of movement in a partiuclar direction from the practitioner’s technique.
    • Promoting deep relaxation by ‘switching off’ tensions from the conscious mind. Stimulation of the fascial mechanoreceptors and suggestion of movement from the practitioner promotes ideomotion by working at a subconscious level. Whilst the motor movement from this subconscious processing is performed voluntarily by the patient (although it seems involuntary) and they are conscious of the movement the overriding tensions from the conscious mind that can inhibit this movement are ‘switched off’.

    Cranial osteopathic techniques may possibly stimulate proprioceptors with direct intracranial effects. 

    Schueler et al (2013 & 2014) found branches from the trigeminal nerve that innervate the dura mater and regulate bloodflow intracranially also innervate extracranial soft tissues. These nerves, in the rat containing proprioceptive fibers (Schueler et al 2014), run a course originating intracranially to then traverse the cranium via the sutures and emissary canals to terminate extracranially. Extracranially these nerves innervate the connective tissue of the temporomandibular joint, periosteum and cervical muscles. Noseda et al (2019) proposed, not only can activation of extracranial muscle nociceptors cause headaches via their intracranial branches innervating the dura but also, in reverse, activation of intracranial dural nociceptors can give rise to extracranial muscle tendernes

    To initiate or facilitate fascia unwinding two conditions must be met (Minasy 2009):

    • The practitioner must posses sensitivity and fine palpation skills.
    • The patient must be able to relax and “let go” of their body.

    Mason (2008) broadened the definition of ideomotion for the treatment of musculoskeletal disorders. This definition included the use of subconscious motor movements necessary to reach a state of comfort. This is achieved by removing the inhibition and suppression of instinctual motor patterns from pain or tension in order to facilitate and encourage ideomotor patterns to emerge (McCarthy et al 2007, Mason 2008). This can be achieved by regulating proprioceptive feedback.

    References

    Massen C and Prinz W (2008). Movements, actions and tool-use actions: an ideomotor approach to imitation (2008). 

    Bertolucci L F (2010). Muscle Repositioning: Combining Subjective and Objective Feedbacks in the Teaching and Practice of a Reflex-Based Myofascial Release Technique

    Sun D, Custers R, Marien H, and  AartsIdeomotor H (2020). Action: Evidence for Automaticity in Learning, but Not Execution 

    Mason J (2008). The use of ideomotor therapy in the treatment of chronic neck pain: A single systems research design

    Schleip R (2017). Fascia as a sensory organ: clinical applications 

    Maquestiaux F, Lyphout-Spitz M, Ruthruff E, ArexisIdeomotor M (2020). Compatibility enables automatic response selection

    McCarthy S, Rickards L, Lucas N (2007). Using the concept of ideomotor therapy in the treatment of a patient with chronic neck pain: A single system research design. 

    Vogel D, Rudolf M, and Scherbaum S (2020). The impact of the verbal instruction and task characteristics on effect-based action control

    Bertolucci LF, Kozasa EH (2010). Sustained Manual Loading of the Fascial System Can Evoke Tonic Reactions: Preliminary Results 

    Minasny B (2009). Understanding the Process of Fascial Unwinding

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    Fuchs T & Koch S (2014). Embodied affectivity: on moving and being moved

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    Johnson M (2015). Embodied understanding

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    Abraham A, Franklin E, Stecco C, Schleip R (2020). Integrating mental imagery and fascial tissue: A conceptualization for research into movement and cognition 

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    Schueler M, Messlinger K, Dux M, Neuhuber WL, De Col R. (2013). Extracranial projections of meningeal afferents and their impact on meningeal nociception and headache

    Schueler M, Neuhuber W, Col R, Messlinger K (2014). Innervation of Rat and Human Dura Mater and Pericranial Tissues in the Parieto‐Temporal Region by Meningeal Afferents

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